NATIONAL 

INSTITUTES OF 

HEALTH

Research Priority 

Setting, and Funding 

Allocations across 

Selected Diseases 

and Conditions

Report to the Chairman, Subcommittee 

on Labor, Health and Human Services, 

Education, and Related Agencies, 

Committee on Appropriations, House 

of Representatives

March 2014

GAO-14-246

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-14-246, a report to the 

Chairman, Subcommittee on Labor, Health 

and Human Services, Education, and Related 

Agencies, Committee on Appropriations, 

House of Representatives

March 2014

NATIONAL INSTITUTES OF HEALTH

Research Priority Setting, and Funding Allocations 

across Selected Diseases and Conditions

Why GAO Did This Study

NIH is the nation’s leader in sponsoring 

and conducting biomedical research. In 

fiscal year 2012, NIH had a budget of 

almost $31 billion, over 80 percent of 

which was used to fund extramural 

research that supports scientists and 

research personnel working at 

universities, medical schools, and 

other research institutions. Twenty-four 

of NIH’s 27 ICs that support extramural 

research are focused on particular 

diseases, conditions, or research 

areas, and these ICs have their own 

appropriations. Decisions about which 

projects are funded are made by these 

individual ICs. NIH reports funding for 

235 research, condition, and disease 

categories in RCDC.

GAO was asked to review NIH funding 

related to leading diseases and health 

conditions. GAO examined (1) how 

research priorities are set at NIH, and 

(2) NIH allocations of research funding 

across selected diseases and 

conditions. For five ICs—National 

Cancer Institute; National Heart, Lung, 

and Blood Institute; National Institute of 

Allergy and Infectious Diseases; 

National Institute of Diabetes and 

Digestive and Kidney Diseases; and 

National Institute of General Medical 

Sciences—GAO reviewed documents 

and interviewed IC officials about 

priority setting. GAO reviewed NIH 

fiscal year 2012 funding reported by 

RCDC for 40 research, condition, and 

disease categories related to the 

leading causes of death in the United 

States and globally, and the most 

prevalent chronic diseases and 

conditions in the United States.

What GAO Found

Individual institutes and centers (ICs) at the National Institutes of Health (NIH) set 

their own research priorities, and GAO found that the five selected ICs—

awarding the largest amount of research funding—that it reviewed did so 

considering similar factors and using various priority-setting approaches. Agency 

officials stated that the ICs’ mission and appropriations inform priority-setting 

approaches. Some IC officials noted that because the costs of potential research 

projects generally exceed the available appropriation, the ICs must prioritize 

among research projects. In priority setting, IC officials reported taking into 

consideration scientific needs and opportunities, gaps in funded research, the 

burden of disease in a population, and public health need, such as an emerging 

public health threat like influenza that needs to be addressed. While each IC 

GAO examined had its own approach for setting priorities, they all considered the 

input of stakeholders, including the scientific community, and used some similar 

strategies. All five ICs developed strategic plans, though the process varied by 

IC. Some ICs also used annual planning activities in various forms, which then 

guided funding opportunity announcements. All five ICs also conducted reviews 

and evaluations of their research portfolios to ensure that their priorities align with 

scientific opportunities, research gaps, and emerging science. In addition to 

these efforts at the IC level, agency officials told GAO that the NIH Office of the 

Director provides leadership and coordinates priority setting activities, especially 

for those activities that involve multiple ICs.

NIH reported funding levels that varied widely for the 40 different Research, 

Condition, and Disease Categorization system (RCDC) categories GAO 

examined that correspond to the leading causes of death and the most prevalent 

chronic conditions. For example, NIH reported actual fiscal year 2012 funding 

levels ranging from $13 million for projects in the fibromyalgia category to more 

than $5.6 billion for projects in the cancer category. Although these categories 

are part of NIH’s RCDC, which is used to categorize the research activities 

across the agency, agency officials said that the system cannot estimate a total, 

non-duplicated amount of funding that is specific to a given disease or condition. 

This is because RCDC categories are neither mutually exclusive nor exhaustive. 

For example, projects may be included in multiple RCDC categories, some 

categories are related to each other and therefore some categories may also be 

included within another, and funding for all diseases is not captured in the 

system. While RCDC is NIH’s official system for reporting research funding 

across the ICs, two of the five ICs that GAO reviewed—the National Cancer 

Institute (NCI) and the National Institute of Allergy and Infectious Diseases—had 

their own systems for tracking their funding, which allowed them to provide more 

detailed information than that available from RCDC. For example, NCI has a 

publicly available website that specifies funding for more than 40 specific cancer 

types as well as almost 50 research topics that are not disease-specific. Funding 

for individual projects may be separated for specific studies into those cancer 

types. According to officials, the system enhances NCI’s ability to plan and 

monitor its scientific investment.

The Department of Health and Human Services provided technical comments, 

which GAO incorporated as appropriate.

View GAO-14-246. For more information, 

contact Linda T. Kohn at (202) 512-7114 or 

kohnl@gao.gov.
Page i GAO-14-246 NIH Priority Setting and Research Funding

Letter 1 

Background 3

Individual Institutes and Centers Set Their Own Research 

Priorities Using a Variety of Approaches, Including Strategic 

Planning, Annual Planning, and Review of Research Portfolios 6

NIH Funding Levels Varied Widely For Selected Categories of 

Research, Conditions, and Diseases Corresponding to the 

Leading Causes of Death and Chronic Conditions 11

Agency Comments 15

Appendix I Studies about the Relationship between Research Funding and 

Burden of Disease 16

Appendix II Leading Causes of Death and Chronic Conditions and their 

Corresponding National Institutes of Health Categories 18

Appendix III GAO Contact and Staff Acknowledgments 25

Tables

Table 1: Reported Funding for Categories in NIH’s Research, 

Condition, and Disease Categorization System (RCDC) 

Corresponding to Leading Causes of Death and Chronic 

Conditions, Fiscal Year 2012 12

Table 2: Leading Causes of Deaths in the United States, 2011 19

Table 3: Leading Causes of Deaths Globally, 2010 20

Table 4: Chronic Disease Prevalence for Adults, United States 21

Table 5: Diseases and Conditions that Represent the Leading 

Causes of Death and Most Prevalent Chronic Diseases 

and Conditions and Corresponding Categorization 22

Contents
Page ii GAO-14-246 NIH Priority Setting and Research Funding

Abbreviations

AIDS acquired immunodeficiency syndrome

CDC Centers for Disease Control and Prevention

DALY disability-adjusted life years 

HHS Department of Health and Human Services 

HIV human immunodeficiency virus

IC institute and center

ICD-10 International Classification of Diseases

NCI National Cancer Institute 

NHLBI National Heart, Lung, and Blood Institute

NIAID National Institute of Allergy and Infectious Diseases

NIDDK National Institute of Diabetes and Digestive and Kidney

 Diseases 

NIGMS National Institute of General Medical Sciences 

NIH National Institutes of Health 

OD Office of the Director 

RCDC Research, Condition, and Disease Categorization system

YLL years of life lost to premature death

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Page 1 GAO-14-246 NIH Priority Setting and Research Funding

441 G St. N.W.

Washington, DC 20548

March 31, 2014

The Honorable Jack Kingston

Chairman

Subcommittee on Labor, Health and Human Services, 

 Education, and Related Agencies

Committee on Appropriations

House of Representatives

Dear Mr. Chairman:

The National Institutes of Health (NIH) is the nation’s leader in sponsoring 

and conducting biomedical research. In fiscal year 2012, NIH, an agency 

of the Department of Health and Human Services (HHS), had a budget of 

almost $31 billion, over 80 percent of which was used to fund extramural 

research that supports scientists and research personnel working at 

universities, medical schools, and other research institutions. NIH also 

funds intramural research performed by NIH scientists in NIH 

laboratories. To fulfill its mission to seek fundamental knowledge about 

the nature and behavior of living systems and the application of that 

knowledge to enhance health, lengthen life, and reduce illness and 

disability, NIH funds research related to life processes and many 

diseases and conditions, including those that are among the leading 

causes of death both in the United States and globally.1

The range of research that NIH funds is reflected in its organization, 

consisting of the Office of the Director (OD) and 27 institutes and centers 

(IC). The ICs that support extramural research are focused on particular 

diseases, conditions, or research areas and are supported by their own 

budget, mission, and staff. Each IC makes final decisions on which 

projects to fund or conduct contingent on the available appropriation or 

funding.2

 

1

According to the Centers for Disease Control and Prevention, leading causes of death in 

the United States in 2011 include diseases of the heart, malignant neoplasms, chronic 

lower respiratory diseases, cerebrovascular disease, and accidents. The most prevalent 

chronic diseases and conditions include obesity, chronic joint symptoms, hypertension, 

untreated dental caries, and arthritis.

Given NIH’s role in biomedical research, its broad mission, and 

2

NIH funds research projects through a range of mechanisms, such as research grants 

and contracts. For the purposes of this report, we refer to relevant NIH-funded research as 

“projects” and do not distinguish between the different types of awards.
 

Page 2 GAO-14-246 NIH Priority Setting and Research Funding

the size of its budget, Congress and researchers have had long-standing 

interest in how NIH establishes research priorities and how those 

priorities guide the allocation of its resources, particularly in relation to 

various diseases and conditions.

You requested that we provide information on federally funded research 

related to diseases and health conditions that are the leading causes of 

death or the most prevalent chronic conditions. In this report, we describe 

(1) how research priorities are set at NIH, and (2) NIH allocations of 

research funding across selected diseases and conditions.

In addition, appendix I of this report summarizes key findings from 

published studies about the relationship between the extent of research 

funded and the burden of diseases being researched, both at NIH and in 

other countries. The research used measures of disease burden, such as 

the prevalence of disease or conditions in a population, hospitalization 

rates, and mortality associated with a particular disease.

To describe how research priorities are set at NIH, we reviewed relevant 

laws and agency guidance, including documents that outline methods for 

setting priorities for research funding from the five ICs that awarded the 

largest amount of research funding in fiscal year 2012.3

To describe research funding allocations across selected diseases and 

conditions, we first identified the leading causes of death in the United 

States, the leading causes of death globally, and the most prevalent 

chronic conditions for adults in the United States. We then identified the 

categories within NIH’s Research, Condition, and Disease Categorization 

system (RCDC) that best matched each disease and condition we 

The five ICs are 

National Cancer Institute (NCI); National Heart, Lung, and Blood Institute 

(NHLBI); National Institute of Allergy and Infectious Diseases (NIAID); 

National Institute of Diabetes and Digestive and Kidney Diseases 

(NIDDK); and National Institute of General Medical Sciences (NIGMS). 

We also interviewed officials from OD and those five ICs about their 

processes for setting priorities for research funding. We did not evaluate 

the appropriateness of the IC’s processes for setting priorities for 

research funding.

 

3

Funding by the five selected ICs constituted approximately 57 percent of total research 

grant funding.
 

Page 3 GAO-14-246 NIH Priority Setting and Research Funding

selected, and we confirmed these matches with NIH. (See app. II for a 

more detailed description of our methodology for identifying the leading 

causes of death, the most prevalent chronic conditions, and their 

corresponding NIH research, condition, and disease categories.) We 

reviewed publically available RCDC funding data from fiscal year 2012 for 

those categories. We also interviewed NIH officials responsible for RCDC 

to understand the data gathered and reported on. We determined that the 

data were sufficiently reliable for the purposes of this review.

We conducted our work from April 2013 to March 2014 in accordance 

with generally accepted government auditing standards. Those standards 

require that we plan and perform the audit to obtain sufficient, appropriate 

evidence to provide a reasonable basis for our findings and conclusions 

based on our audit objectives. We believe that the evidence obtained 

provides a reasonable basis for our findings and conclusions based on 

our audit objectives.

As the central office for NIH, OD establishes NIH policy and broad 

themes for the agency to pursue, such as ensuring a sustainable 

scientific workforce, based on national needs and scientific opportunities. 

In addition, the OD is responsible for coordinating the programs and 

activities that span NIH components, particularly research initiatives and 

issues involving more than 1 of the 27 ICs. OD is also responsible for 

ensuring that scientifically-based strategic planning is implemented in 

support of research priorities, and that NIH’s resources are sufficiently 

allocated for research projects identified in strategic plans. NIH conducts 

and sponsors biomedical research through its ICs, each of which is 

charged with a specific mission. ICs’ missions generally focus on a 

specific disease, a particular organ, or a stage in life, such as childhood 

or old age. The ICs support, plan, and manage their own research 

programs in keeping with OD policy and priorities. Within an IC, there can 

be a number of offices, centers, and divisions that focus on specific 

aspects of the IC’s mission. For example, NCI has a Division of Cancer 

Epidemiology and Genetics, as well as a Division of Cancer Treatment 

and Diagnosis.

Background

NIH’s Organization
 

Page 4 GAO-14-246 NIH Priority Setting and Research Funding

ICs accomplish their missions chiefly through extramural and intramural 

research. Extramural research accounted for more than 80 percent of 

NIH’s budget in fiscal year 2012. This research is conducted at 2,500 

universities, medical schools, research organizations, and companies 

who are awarded extramural research grants or extramural research and 

development contracts through NIH’s competitive process. Twenty-four of 

the 27 ICs fund extramural research projects, and these ICs make final 

decisions on which extramural research projects to fund following a 

standard peer review process.4

program announcements

Most IC extramural funding is provided for 

what NIH considers “unsolicited” research and research training projects 

for which applications are submitted in response to broad funding 

opportunity announcements that span the breadth of the NIH mission. In 

addition, to encourage and stimulate research and the submission of 

research applications in specific areas, many ICs will issue solicitations 

that are more narrow in scope in the form of , 

requests for applications, and requests for proposals.5 When reviewing 

applications for extramural research projects, NIH follows a process of 

peer review, established by law.6

 

4

These 24 ICs receive specific appropriations, distinct from others available to NIH, such 

as the Office of the Director. 

This peer review system has two 

sequential levels of peer review. According to NIH officials, the first level 

involves panels of experts to assess the scientific merit of the proposed 

science. The second level involves panels of experts and leaders of nonscience fields including patient advocates that, in addition to scientific 

merit, also consider the IC’s mission and strategic plan goals, public 

health needs, scientific opportunities, and portfolio balance. After NIH’s 

5

A program announcement identifies areas of increased priority and/or emphasis for a 

specific area of science. A request for application identifies an area for which one or more 

NIH institutes have set aside funds for awarding grants. A request for proposal solicits 

contract proposals.

6

See 42 U.S.C. §§ 282(b)(9) (the Director of NIH must ensure that NIH research 

undergoes peer review and advisory council review); 289a(a) (peer review); 289a-1(a)(2) 

(advisory council review).

Extramural and Intramural 

Research Supported by 

NIH
 

Page 5 GAO-14-246 NIH Priority Setting and Research Funding

peer review process is concluded, IC directors make extramural funding 

decisions.7

Intramural research, which accounts for approximately 10 percent of 

NIH’s budget, is conducted by NIH scientists in NIH laboratories. This 

includes about 5,300 scientists and technical support staff who are 

employees, and another 5,000 young scientists at various stages of 

research training who come to NIH for a few years to work as nonemployee trainees, including 3,800 postdoctoral fellows. All but 3 of the 

27 ICs have an intramural research program, but the size, structure, and 

activities of the programs vary greatly.8

In January 2007, Congress directed NIH to establish an electronic system 

to categorize the research grants and activities of OD and all the ICs.9

 

7

NIH may not approve or fund any application unless it has been recommended for 

approval by a majority of the members of the initial peer review group and a majority of the 

voting members of an IC’s advisory council. The initial peer review groups recommend 

applications for approval by means of a scoring system. 42 U.S.C. § 289a-1(a)(2). In 

general, advisory councils (or advisory boards) consist of no more than 18 voting 

members, two-thirds of whom are scientists in the research areas of the IC and one-third 

of whom are leaders of non-science fields. Advisory councils also include ex officio 

members who are nonvoting.

In 

response, NIH created RCDC. Implemented in February 2008, RCDC 

uses a computer-based text-mining tool that recognizes words and 

phrases in project descriptions in order to assign NIH projects to at least 

one of 235 categories of diseases, conditions, and research areas that 

8

Given their missions, the Fogarty International Center, the Center for Information 

Technology, and the Center for Scientific Review do not have an intramural research 

component. For example, the Center for Scientific Review serves as the portal for NIH 

grant applications and their review for scientific merit.

9

National Institutes of Health Reform Act of 2006, Pub. L. No. 109-482, § 104, 120 Stat. 

3675, 3689 (2007) (adding § 403B to the Public Health Service Act, codified at 42 U.S.C. 

§ 282b). The House committee of reference indicated that this language was intended to 

address a recommendation made in an Institute of Medicine report to standardize data 

and information management systems by creating a comprehensive electronic reporting 

system that would catalogue all of the research activities of the NIH in a standardized 

format. H. Rep. No. 109-687, at 4 – 5 (2006), referring to Institute of Medicine, 

Responding to Health Needs and Scientific Opportunity: The Organizational Structure of 

the National Institutes of Medicine, (Washington, D.C.; Oct. 16, 1984).

NIH’s Research, 

Condition, and Disease 

Categorization System
 

Page 6 GAO-14-246 NIH Priority Setting and Research Funding

were developed for reporting to Congress and the public.10 NIH officials 

said that RCDC serves as NIH’s primary computerized reporting process 

to categorize its research funding.11 The system includes reporting tools 

that can be used to generate publically-available, web-based reports on 

total funding amounts for the research projects related to each RCDC 

category.

Individual ICs at NIH set their own research priorities, and we found that 

the five selected ICs we reviewed did so considering similar factors and 

using various priority-setting approaches. Officials at all five of the ICs 

stated that their mission and available appropriations inform priority 

setting approaches. Officials at one IC noted that their IC’s mission 

provides context related to why the IC was developed initially and insight 

into the emerging areas of research. Officials stated that an IC’s 

appropriations not only set funding parameters, but may also influence 

priority setting if the appropriations include mandated spending by 

Congress for a specific disease.12 Some IC officials noted that because 

the costs of potential research projects generally exceed the available 

appropriation, the ICs generally must prioritize among research projects. 

In priority setting, IC officials also reported taking into consideration 

scientific needs and opportunities, gaps in funded research, the burden of 

disease in a population, and public health need, such as an emerging 

public health threat that needs to be addressed, like influenza.

 

10The text mining tool is used in conjunction with NIH definitions—a list of terms and 

concepts selected by NIH experts to define a research category—to match research 

projects to categories. Projects may fall into one or more categories. There are additional 

categories that are not reported publicly for issues such as climate change for a total of 

approximately 270 categories.

11RCDC tracks projects funded by three different types of NIH funding: extramural 

research grants, research and development contracts, and intramural research conducted 

in NIH’s own laboratories and clinics. Information on funding totals and projects within 

each category is available on the NIH website. See “Estimates of Funding for Various 

Research, Condition, and Disease Categories (RCDC)” accessed November 25, 2013, 

http://www.report.nih.gov/categorical_spending.aspx.

12According to NIH officials, an example of an appropriation that includes mandated 

spending for a specific disease is for type I diabetes.

Individual Institutes 

and Centers Set Their 

Own Research 

Priorities Using a 

Variety of 

Approaches, 

Including Strategic 

Planning, Annual 

Planning, and Review 

of Research 

Portfolios
 

Page 7 GAO-14-246 NIH Priority Setting and Research Funding

While individual ICs used different approaches to priority setting, all five 

selected ICs we reviewed reported using some combination of strategic 

planning, annual planning, and periodic review and evaluation of their 

research portfolios as part of their approach to priority setting.

Strategic planning: All five ICs we interviewed developed strategic 

plans—consistent with law and NIH policy—to set priorities and goals for 

research funding.13

• NIAID used a framework organized around various scientific areas 

that encompassed its research to develop the strategic plans it 

published in 2000, 2008, and 2013.

According to officials at selected ICs, the 

development of these plans is guided by various processes at each IC. 

Although these processes vary by IC, they include an opportunity to solicit 

input from stakeholders, including the scientific community, as well as 

review by IC staff and leadership. Examples of IC strategic planning 

activities include the following:

14 When developing the plans, 

NIAID convened groups of NIAID subject matter experts for each 

scientific area and considered input offered by external organizations 

and scientists to guide the process. The experts deliberated priorities 

identified for each scientific area and suggested revisions to the draft 

plan. For example, officials stated that NIAID has seen a shift in the 

emphasis on research efforts related to human immunodeficiency 

virus/acquired immunodeficiency syndrome (HIV/AIDS) from studying 

single-drug therapy to the current focus on finding improved HIV 

treatments and tools for preventing infection. This new focus was then 

incorporated as part of the strategic plan published in 2013. Draft 

strategic plans were reviewed by the NIAID Advisory Council.15

 

13See 42 U.S.C. § 282(b)(5).

After 

a final review by the director of NIAID, the finalized plans were 

published on NIAID’s web site.

14For example, NIAID included four scientific areas of emphasis in the 2013 strategic plan: 

human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS); 

infectious diseases (non-AIDS), including emerging and re-emerging disease and 

biodefense; allergy, immunology, and immune-mediated diseases; and global health 

research.

15Each IC’s Advisory Council not only conducts the second level of NIH’s peer review but 

also offers advice and recommendations on policy and program development, program 

implementation, evaluation, and other matters of significance to the mission and goals of 

the IC.
 

Page 8 GAO-14-246 NIH Priority Setting and Research Funding

• NHLBI officials said that, as of November 2013, the IC was revising 

the strategic plan it published in 2007 and part of its strategic planning 

process under the direction of a new director appointed in 2012. As 

part of the revised process, NHLBI created the Strategic Investment 

and Management Steering Committee that will help establish strategic 

goals as well as advise leadership about whether proposed activities 

are consistent with the IC’s strategic plan. Officials stated that the 

strategic planning process will engage both NHLBI scientific staff as 

well as the larger extramural community because they are 

knowledgeable about research gaps within their respective fields. 

Further, NHLBI officials stated that input provided by stakeholders 

also helps to inform development of disease-specific planning 

documents, such as one for asthma and another on sleep disorders.

Annual planning activities: In addition to the development of strategic 

plans, some IC officials we interviewed told us that they conduct annual 

planning activities as a part of their process to set priorities for research 

funding. They told us that these annual planning activities address 

ongoing and emerging needs. While the processes vary across the ICs in 

terms of the level of structure and formality, officials stated that during the 

annual planning process these ICs typically consider factors such as 

scientific needs, research gaps, scientific opportunities, public health 

needs, and the need to balance the various types of research conducted 

to address all areas of the mission. Examples of annual planning activities 

include the following:

• NIAID uses an annual planning process to develop and select 

initiatives that address special needs, gaps, and opportunities in 

relevant research areas. According to NIAID officials, these initiatives 

are developed through a structured process centered around two 

primary events—the annual Summer Policy Retreat and the annual 

Winter Program Review. NIAID staff also review their scientific areas 

for the latest information on burden of illness and state of scientific 

progress, which is used to inform the development of future initiatives. 

According to agency officials, NIAID staff use this information, as well 

as input from the scientific community, to prepare and present a 

concept of an initiative to NIAID’s National Advisory Council, which 

reviews, comments on, and decides whether to approve the initiative. 

Once an initiative has been approved, NIAID solicits research 

applications through a request for application, a program 

announcement, or a request for proposal.

• NIDDK uses an annual process that requires NIDDK scientific 

program staff within the IC’s divisions to review the research portfolio 
 

Page 9 GAO-14-246 NIH Priority Setting and Research Funding

and to identify research opportunities. According to NIDDK, this effort 

is informed by a number of factors, such as ongoing input from the 

extramural research and health advocacy communities and recent 

research advances. They said that each division then presents 

initiative concepts built on these research opportunities at NIDDK 

senior leadership meetings. The NIDDK director prioritizes the 

initiative concepts and determines which will move forward based on 

consideration of merit and other factors. These concepts go through a 

clearance process, including review from the NIDDK National 

Advisory Council. NIDDK develops funding opportunity 

announcements based on these identified research opportunities, 

such as requests for application that address specific scientific 

questions or diseases. In addition, NIDDK conducts divisional 

planning and prioritization activities during monthly meetings, retreats, 

and other activities, including consideration of opportunities for funds 

to support targeted emphasis areas.

Review and evaluation of research portfolio: Officials from the five 

selected ICs we interviewed stated they conduct reviews of their research 

portfolio to help ensure existing priorities reflect and align with current 

scientific opportunities, research gaps, and emerging science. This 

includes periodic formal program assessments of their research portfolio, 

which the ICs used to determine if the IC is meeting its overall priorities 

and goals, to maintain portfolio balance, and to make any changes to 

priorities over time as science evolves. Examples of portfolio review and 

evaluation activities include the following:

• NCI officials stated that the IC conducts portfolio analyses, which 

involve examining research areas NCI has funded to identify 

opportunities for research. Officials stated that the portfolio analysis is 

an iterative process that occurs continually throughout the year. One 

example of this portfolio analysis has involved publishing broad 

questions related to five themes for the research community on NCI’s 

website and using the responses received to inform development of 

requests for application and program announcements published by 

NCI.16

 

16The five themes are: cancer prevention and risk; mechanisms of tumor development 

and recurrence; tumor detection, diagnosis, and prognosis; cancer therapy and outcomes; 

and clinical effectiveness. 

Officials said they aim to generate about four new questions 

each year and that the questions are generally very broad and do not 
 

Page 10 GAO-14-246 NIH Priority Setting and Research Funding

usually address specific diseases. For example, one question recently 

asked how the level, type, or duration of physical activity influences 

cancer risk and prognosis.

• NIGMS conducts formal program evaluations to determine what 

benefits the program has produced overall, including scientific 

advances, new technologies, and cutting-edge paradigm shifts, such 

as changes in the understanding of human biology. In addition, 

officials told us that NIGMS divisions conduct an annual review, which 

is generally prepared for NIGMS’s director, and provides information 

about the scientific advances that can be attributed to the work 

conducted in each division. This includes items such as the number of 

grants funded, the number of new principal investigators, the types of 

research conducted, and an overview of any new science performed.

While the individual ICs set their own priorities, according to NIH officials, 

the OD provides leadership to the ICs and helps coordinate priority 

setting activities, especially for efforts that involve multiple ICs. For 

example, NIH officials reported that the director of NIH meets with all IC 

directors weekly to discuss research priorities, investments, and concerns 

that may affect an IC or NIH overall. In addition, the Advisory Committee 

to the Director assists the director of NIH with making major planning and 

policy decisions, including those related to research priorities and the 

allocation of funds for major, NIH-wide projects and identifies areas that 

have the potential for significant improvements both within NIH and within 

the scientific community at large. For example, the NIH Director charged 

the committee with examining NIH’s data needs to determine whether the 

agency is positioned to handle significant amounts of data and how to 

make these data accessible to researchers. In addition, NIH established a 

special division within the Office of the Director—the Division of Program 

Coordination, Planning, and Strategic Initiatives—to help manage large 

and complex research portfolios across NIH. The offices within this 

division organize formal discussions to obtain input from all of the IC 

directors as well as members of the scientific community to identify areas 

of significant scientific interest or need that typically span the interests of 

multiple ICs. NIH officials also stated that although each IC has at least 

one strategic plan in place, in some instances NIH has developed 

strategic plans for particular disease or topic areas that cross multiple 

ICs, such as one related to women’s health research.
 

Page 11 GAO-14-246 NIH Priority Setting and Research Funding

In fiscal year 2012, NIH reported funding levels that ranged widely—from 

$13 million for projects in one RCDC category to more than $5.6 billion for 

another—for the 40 different RCDC categories we examined. (See 

table 1.) We determined that these RCDC categories were the best match 

for the most frequent causes of death in the United States,17 the most

frequent causes of death globally,18 and the most prevalent chronic 

conditions in the United States.19 (See app. II for an explanation of how 

we identified these diseases and conditions and matched them with 

RCDC categories.)

 

17D. L. Hoyert and J. Xu, National Center for Health Statistics, “Deaths: Preliminary Data 

for 2011,” National Vital Statistics Reports, vol. 61, no. 6 (Oct. 10, 2012).

18R. Lozano et al., “Global and Regional Mortality from 235 Causes of Death for 20 Age 

Groups in 1990 and 2010: A Systematic Analysis for the Global Burden of Disease Study 

2010,” The Lancet, vol. 380 (2012).

19CDC provided data for the most prevalent chronic conditions based on a variety of 

sources.

NIH Funding Levels 

Varied Widely For 

Selected Categories 

of Research, 

Conditions, and 

Diseases 

Corresponding to the 

Leading Causes of 

Death and Chronic 

Conditions
 

Page 12 GAO-14-246 NIH Priority Setting and Research Funding

Table 1: Reported Funding for Categories in NIH’s Research, Condition, and

Disease Categorization System (RCDC) Corresponding to Leading Causes of Death 

and Chronic Conditions, Fiscal Year 2012

NIH RCDC category corresponding to a leading 

cause of death or chronic condition

Fiscal year 2012 funding

reported in RCDC

($ millions)

Alzheimer’s disease

a

$503

Arthritis 258

Asthma 229

Breast cancer 800

Cancer 5,621

Cardiovascular 2,040

Cervical cancer 112

Childhood leukemia 77

Chronic liver disease and cirrhosis 288

Chronic obstructive pulmonary disease 101

Colo-rectal cancer 302

Dental/oral and craniofacial disease 516

Diabetes 1,061

Emphysema 20

Epilepsy 156

Fibromyalgia 13

Heart disease 1,278

Heart disease - coronary heart disease 468

HIV/AIDS 3,074

Hypertension 215

Infant mortality/low birth weight 287

Influenza 251

Injury (total) accidents/adverse effects 366

Kidney disease 556

Liver cancer 73

Lung cancer 233

Lupus 108

Lymphoma 213

Malaria 152

Obesity 836

Pancreatic cancer 127

Parkinson’s disease 154
 

Page 13 GAO-14-246 NIH Priority Setting and Research Funding

NIH RCDC category corresponding to a leading 

cause of death or chronic condition

Fiscal year 2012 funding

reported in RCDC

($ millions)

Perinatal period - conditions originating in perinatal period

a

538

Pneumonia 115

Pneumonia and influenza 358

Prostate cancer 257

Septicemia 96

Stroke 310

Suicide 44

Tuberculosis 218

Source: GAO analysis of NIH data.

Notes: Leading causes of death in the United States were identified from D. L. Hoyert and J. Xu, 

National Center for Health Statistics, “Deaths: Preliminary Data for 2011,” National Vital Statistics 

Reports, vol. 61, no. 6 (Oct. 10, 2012). Leading causes of death globally were identified from R. 

Lozano et al., “Global and Regional Mortality from 235 Causes of Death for 20 Age Groups in 1990 

and 2010: A Systematic Analysis for the Global Burden of Disease Study 2010,” The Lancet, vol. 380 

(2012). Data for the most prevalent chronic conditions were provided by the Centers for Disease 

Control and Prevention based on a variety of sources.

a

NIH officials said that RCDC is the agency’s official system for reporting 

research funding across the agency’s ICs and it provides a method for 

reporting consistent information about NIH funding. As noted by the 

agency, RCDC produces standard reports across all ICs using a process 

that is reproducible. To facilitate this, all ICs are to use the same 

definitions of research, diseases, and conditions for the RCDC 

categories. Further, the system allows for detailed reports, including the 

total funding for a category as well as specific information about the 

projects under each category, such as the title of the project, the IC 

supporting the research, and the project number.

RCDC categories are not mutually exclusive. Because of this, NIH officials stated, RCDC is not 

designed to be used to determine the proportion of NIH funding specific to a given disease or 

condition.

Agency officials said that the system was not designed to be able to 

estimate a total, non-duplicated amount of funding specific to a given 

disease or condition because RCDC categories are neither mutually 

exclusive nor exhaustive. Specifically:

• Projects may be reported in multiple categories. NIH officials said that 

the categories within the system are not mutually exclusive and 

therefore a project may be included in multiple categories. Officials 

told us that, on average, a single project may fall into five or six RCDC 

categories.
 

Page 14 GAO-14-246 NIH Priority Setting and Research Funding

• Categories may be contained in another category. Some categories 

are inherently related and therefore an entire RCDC category can also 

be contained in another category. For example, the category of 

cancer includes other cancer categories, such as breast cancer, lung 

cancer, or prostate cancer, and the research funding reported in each 

of these categories will also be reported in the cancer research total.

• Categories do not exist for all diseases. RCDC also does not capture 

the funding for all diseases that NIH studies. As of November 2013, 

RCDC publicly reported on 235 different categories, but agency 

officials told us that there are an additional 30 to 40 categories used 

for congressional reporting only, and about 50 categories on a waiting 

list to be developed for inclusion in the system.

• Not all projects that NIH funds are included. The protocols that NIH 

develops for tracking funding include certain thresholds for inclusion. 

Therefore, a project that is only minimally related to a particular 

category may not be included in the funding for that category because 

the description of the project does not adequately match the terms 

defining that category. NIH officials told us that 3 to 5 percent of NIH 

funded research projects do not appear in any RCDC category.

Some ICs have their own systems that track and report funding within 

their research portfolios. Of the five selected ICs we reviewed, two had 

their own systems for tracking their funding.

• NCI maintains a publicly available website that communicates funding 

decisions across the research supported by NCI. The system was 

developed in 1998 and categorizes research into more than 40 

specific cancer types, as well as almost 50 research topics that are 

not disease-specific. Funding for individual projects may be separated 

and reported in the NCI system by the specific types of cancers being 

studied. According to NIH officials, the system is limited to those 

research projects funded by NCI and therefore does not include 

information about research studies addressing cancer that are funded 

solely by other ICs. NCI officials told us that they use the system to 

report data to stakeholders, including Congress, and that the analyses 

they conduct based on these data enhance NCI’s ability to plan and 

monitor its scientific investment.

• NIAID also has an internal coding system which, according to agency 

officials, was instituted in 1979 and codes each individual research 

project it funds by areas of study. Staff members manually assign 

codes. NIAID officials noted that projects may have multiple codes 

depending on the specific goals of the project, and these codes reflect 
 

Page 15 GAO-14-246 NIH Priority Setting and Research Funding

the percentage of relevance to that specific goal, such that the total 

values add to 100 percent. Officials noted that the system helps NIAID 

respond to requests for funding information that is not included in 

RCDC. For example, when addressing a question about how much 

NIAID has invested in influenza research, officials said they examine 

research project funding for the various subtypes of influenza such as 

H1N1 and avian influenzas (including H5N1 and H7N9). These 

subcategories are included in the internal coding system, but are not 

covered by RCDC. Officials noted that NIAID uses RCDC for the 

official budget numbers that NIH reports to Congress.

We provided a draft of this report to HHS. The Department provided 

technical comments, which we incorporated as appropriate.

As agreed with your office, unless you publicly announce the contents of 

this report earlier, we plan no further distribution until 30 days from the 

report date. At that time, we will send copies to the Secretary of the 

Department of Health and Human Services, the Director of the National 

Institutes of Health, and other interested parties. In addition, the report will 

be available at no charge on the GAO website at http://www.gao.gov. 

If you or your staff have any questions about this report, please contact

me at (202) 512-7114 or kohnl@gao.gov. Contact points for our Offices of 

Congressional Relations and Public Affairs may be found on the last page 

of this report. Major contributors to this report are listed in appendix III.

Sincerely yours,

Linda T. Kohn

Director, Health Care

Agency Comments
Appendix I: Studies about the Relationship 

between Research Funding and Burden of 

Disease

Page 16 GAO-14-246 NIH Priority Setting and Research Funding

To provide information on studies about the relationship between 

research funding and burden of disease at the National Institutes of 

Health (NIH) and in other countries, we identified such studies relevant to 

NIH through on-line searches and we provide information on the two most 

recent of the studies. Additionally, for other countries, we identified 

published studies through a search of various databases, and we provide 

information from two of the more recent such studies.1

Studies have been conducted that examine the relationship between 

research funding and burden of disease in the United States and other 

countries. Some researchers have reported that no single measure of 

disease burden captures the impact of various diseases and that different 

measures of burden may result in different conclusions about funding.

We did not identify 

research funding levels in other countries.

Studies on the relationship between research funding by NIH and burden 

of disease found varied relationships depending upon the burden of 

disease measures used. For example,

• A 2013 study assessed the allocation of research funds across 107 

diseases using NIH’s Research, Condition, and Disease 

Categorization system (RCDC) funding data and found a strong and 

statistically significant relationship between NIH funding and deaths 

and hospitalizations.2

• A 2011 study to assess the correlation between NIH research funding 

and burden of disease using data from 2004 and 2006 found that 

current levels of NIH disease-specific research funding correlated 

modestly with U.S. disease burden.

As a result, according to the study, the data 

suggest that NIH funding is responsive to these two measures of 

disease burden. Further, the study noted that the data were consistent 

with the argument that it is more feasible for NIH to respond to 

disease burden considerations through directed or applied research 

funding, such as funding for clinical trials, than through investigatorinitiated basic research.

3

 

1

Some of the databases we searched included Medline, EMBASE, and SciSearch, among 

others.

The study noted that there could 

2

B.N. Sampat, K. Buterbaugh, and M. Perl, “New Evidence on the Allocation of NIH Funds 

across Diseases,” The Milbank Quarterly, vol. 91, no. 1 (2013).

3

Leslie A. Gilum et al., “NIH Disease Funding Levels and Burden of Disease,” PLoS One, 

vol. 6, no. 2 (Feb. 2011). These data predate RCDC.

Appendix I: Studies about the Relationship 

between Research Funding and Burden of 

Disease
Appendix I: Studies about the Relationship 

between Research Funding and Burden of 

Disease

Page 17 GAO-14-246 NIH Priority Setting and Research Funding

be a number of reasons that alignment of funding and burden of 

disease were not better correlated, including that basic science 

research has consistently accounted for 55 percent of NIH spending 

and it is difficult to attribute to a specific disease, contributing 

uncertainty to the analysis and reducing correlations. Measures of 

burden of disease for this study were incidence, prevalence, mortality, 

years of life lost to premature death (YLL), and disability-adjusted life 

years (DALY).4

Studies of research funding in other countries have also found variations 

in relationships between funding and burden of disease. For example,

• A 2012 study found that research expenditures by governmental 

agencies and charities for four of the foremost chronic diseases in the 

United Kingdom—cancer, coronary heart disease, stroke and 

dementia—was not aligned with burden of disease.5

• A 2004 study found a significant relationship between research 

funding by the National Health and Medical Research Council in 

Australia and several measures of burden of disease,

Specifically, 

research funding for dementia and stroke was disproportionately small 

in comparison with funding for cancer and coronary heart disease. In 

this study, burden of disease was measured by prevalence and 

DALYs.

6 with some 

variations over the 6-year span reviewed in the study using different 

measures.7

 

4

Incidence is the number of newly diagnosed cases of a disease during a given a period 

of time. Prevalence is how many people have a disease at any given moment in time. 

Disability-adjusted life years (DALY) is the sum of years of life lost due to premature death 

(YLL) and the years lived with a disability. 

Measures of burden of disease for this study were 

incidence, mortality, YLLs, years of life lost to disability, and DALYs.

5

R. Luengo-Fernandez, J. Leal, and A.M. Gray. “UK Research Expenditure on Dementia, 

Heart Disease, Stroke and Cancer: Are Levels of Spending Related to Disease Burden?” 

European Journal of Neurology, vol. 19 (2012).

6

The National Health and Medical Research Council is the main Australian body charged 

with the responsibility of supporting medical and public health research and training in 

Australia. 

7

S. Aoun, “To What Extent Is Health and Medical Research Funding Associated with the 

Burden of Disease in Australia?” Australian and New Zealand Journal of Public Health,

vol. 28, no.1 (2004).
Appendix II: Leading Causes of Death and 

Chronic Conditions and their Corresponding 

National Institutes of Health Categories

Page 18 GAO-14-246 NIH Priority Setting and Research Funding

To determine the leading causes of death in the United States, we 

reviewed data on causes of death in 2011 that were reported by the 

Centers for Disease Control (CDC).1 First, we identified the 15 leading 

causes of death reported by CDC. Then, we identified subcategories of 

those leading causes of death. To do so, we used as the cut off the 

number of deaths for the 15th leading cause of death—which was 18,090 

deaths from pneumonitis due to solids and liquids. We included those 

sub-categories of causes of death, for example pneumonia, where the 

number of deaths reported was greater than 18,090. See table 2 for the 

leading causes of deaths in the United States in 2011, including the subcategories with at least 18,090 related deaths in 2011, and the number of 

deaths attributed to these causes.

 

1

D. L. Hoyert and J. Xu, National Center for Health Statistics, “Deaths: Preliminary Data 

for 2011,” National Vital Statistics Reports, vol. 61, no. 6 (Oct. 10, 2012).

Appendix II: Leading Causes of Death and 

Chronic Conditions and their Corresponding 

National Institutes of Health Categories
Appendix II: Leading Causes of Death and 

Chronic Conditions and their Corresponding 

National Institutes of Health Categories

Page 19 GAO-14-246 NIH Priority Setting and Research Funding

Table 2: Leading Causes of Deaths in the United States, 2011

Rank Cause of death (Subcategories) Number of deaths

1 Diseases of heart 596,339

Ischemic heart diseases 374,601

Hypertensive heart disease 33,383

2 Malignant neoplasms 575,313

Malignant neoplasms of trachea, bronchus and lung 156,614

Malignant neoplasms of lymphoid, hematopoietic and related tissue 56,263

Malignant neoplasms of colon, rectum and anus 52,243

Malignant neoplasm of breast 41,271

Malignant neoplasm of pancreas 37,371

Malignant neoplasm of prostate 27,929

Malignant neoplasms of liver and intrahepatic bile ducts 21,519

3 Chronic lower respiratory diseases 143,382

4 Cerebrovascular diseases 128,931

5 Accidents (unintentional injuries) 122,777

Non-transport Accidents 85,502 

Transport Accidents 37,275

6 Alzheimer’s disease 84,691

7 Diabetes mellitus 73,282

8 Influenza and pneumonia 53,667

Pneumonia 52,136

9 Nephritis, nephrotic syndrome and nephrosis 45,731

Renal failure 43,682

10 Intentional self-harm (suicide) 38,285

Intentional self-harm (suicide) by discharge of firearms 19,766

Intentional self-harm (suicide) by other and unspecified means and their sequelae 18,519

11 Septicemia 35,539

12 Chronic liver disease and cirrhosis 33,539

13 Essential hypertension and hypertensive renal disease 27,477

14 Parkinson’s disease 23,107

15 Pneumonitis due to solids and liquids 18,090

Source: GAO analysis of data from Centers for Disease Control and Prevention.

Note: See D. L. Hoyert and J. Xu, National Center for Health Statistics, “Deaths: Preliminary Data for 

2011,” National Vital Statistics Reports, vol. 61, no. 6. (Oct. 10, 2012).
Appendix II: Leading Causes of Death and 

Chronic Conditions and their Corresponding 

National Institutes of Health Categories

Page 20 GAO-14-246 NIH Priority Setting and Research Funding

To determine the leading causes of death globally, we reviewed the 

analysis in the Global Burden of Disease Study.2

Table 3: Leading Causes of Deaths Globally, 2010

We identified the 15 

leading causes of death globally in 2010 that were reported in this study. 

See table 3 for the leading causes of deaths globally.

Rank Cause of death

1 Ischemic heart disease

2 Stroke 

3 Chronic obstructive pulmonary disease 

4 Lower respiratory infections

5 Lung cancer

6 HIV/AIDS

7 Diarrheal diseases

8 Road injury

9 Diabetes

10 Tuberculosis

11 Malaria

12 Cirrhosis 

13 Self-harm

14 Hypertensive heart disease

15 Preterm birth complications

Source: R. Lozano et al., “Global and Regional Mortality from 235 Causes of Death for 20 Age Groups in 1990 and 2010: a Systematic 

Analysis for the Global Burden of Disease Study 2010,” The Lancet, vol. 380 (2012).

To determine the most prevalent chronic diseases and conditions in the 

United States, CDC provided us with a list of the 13 most prevalent 

chronic diseases and conditions for adults, and four subcategories. See 

table 4 for a list of the most prevalent chronic diseases and conditions for 

adults identified by CDC.

 

2

R. Lozano et al., “Global and Regional Mortality from 235 Causes of Death for 20 Age 

Groups in 1990 and 2010: a Systematic Analysis for the Global Burden of Disease Study 

2010,” The Lancet, vol. 380 (2012). This study was conducted to provide reliable and 

timely information on the leading causes of death in populations as crucial input into 

health policy debates. In the study, the authors aimed to estimate annual deaths for the 

world and 21 regions between 1980 and 2010 for 235 causes.
Appendix II: Leading Causes of Death and 

Chronic Conditions and their Corresponding 

National Institutes of Health Categories

Page 21 GAO-14-246 NIH Priority Setting and Research Funding

Table 4: Chronic Disease Prevalence for Adults, United States

Rank

Chronic diseases and conditions 

(Sub-categories)

Number of adults impacted

(in 1,000s)

1 Obesity Not reported

2 Chronic joint symptoms 68,749

3 Hypertension 58,959

4 Untreated dental caries Not reported

5 Arthritis diagnosis 53,782

6 Asthma - ever had 29,041

7 Heart disease (total) 26,485

Heart disease (coronary) 15,300

8 Diabetes 20,589

9 Any cancer 19,025

Breast cancer 3,221

Prostate cancer 2,280

Cervical cancer 1,188

10 Asthma - still has 18,869

11 Stroke (cerebrovascular diseases) 6,171

12 Emphysema 4,680

13 Epilepsy 2,300

Source: Centers for Disease Control and Prevention.

Note: The Centers for Disease Control and Prevention provided data for the most prevalent chronic 

conditions based on a variety of sources.

To determine the corresponding categories from the National Institutes of 

Health’s (NIH) Research, Condition, and Disease Categorization system 

(RCDC) for the diseases and conditions that are the leading causes of 

death in the United States, the leading causes of death globally, and the 

most prevalent chronic diseases and conditions in the United States, we 

identified the International Classification of Diseases (ICD-10) codes 

associated with each of these diseases and conditions and, using their 

related descriptions, compared them with the RCDC category 

descriptions. We then provided our list of diseases, conditions, and ICD10 codes with the corresponding RCDC categories to NIH for the 

agency’s review and concurrence. NIH officials confirmed most of our 

matches. For some of the diseases and conditions, officials noted the 

RCDC category that we identified was the closest match, but the category 

was substantially broader than the RCDC category it was selected to 

represent or it was substantially narrower than the RCDC category it was 

selected to represent. In other cases, NIH officials noted that there was 
Appendix II: Leading Causes of Death and 

Chronic Conditions and their Corresponding 

National Institutes of Health Categories

Page 22 GAO-14-246 NIH Priority Setting and Research Funding

not an RCDC category that was a close enough fit to the disease 

category we were trying to represent. See table 5 for the leading causes 

of death in the United States and globally, as well as the most prevalent 

chronic diseases and conditions, and their corresponding RCDC category 

or categories.

Table 5: Diseases and Conditions that Represent the Leading Causes of Death and Most Prevalent Chronic Diseases and 

Conditions and Corresponding Categorization

Diseases and conditions

Leading cause 

of U.S. deaths

Leading cause 

of global deaths

Most prevalent U.S 

chronic diseases/ 

conditions

Research, Condition, and 

Disease Categorization 

system (RCDC)

Accidents (unintentional injuries) x Injury (total) accidents/adverse 

effects

Alzheimer’s disease x Alzheimer’s disease

Arthritis (diagnosis) x Arthritis; lupus; fibromyalgia

Asthma - ever had x Asthma

Asthma - still has x Asthma

Cancer (any) x Cancer

Cancer of the breast x Breast cancer

Cancer of the cervix x Cervical cancer

Cancer of the lung x Lung cancer

Cancer of the prostate x Prostate cancer

Cerebrovascular disease x Stroke 

Chronic joint symptoms x No RCDC match

Chronic liver disease and cirrhosis x Chronic liver disease and 

cirrhosis

Chronic lower respiratory diseases x Asthma; chronic obstructive 

pulmonary disease; 

emphysema

Chronic obstructive pulmonary disease x Chronic obstructive pulmonary 

disease; emphysema

Cirrhosis x Chronic liver disease and 

cirrhosis

Diabetes mellitus x Diabetes

Diabetes x x Diabetes

Diarrheal diseases x No RCDC match

Diseases of the heart x Cardiovascular

Emphysema x Emphysema

Epilepsy x Epilepsy

Essential hypertension and 

hypertensive renal disease

x Hypertension
Appendix II: Leading Causes of Death and 

Chronic Conditions and their Corresponding 

National Institutes of Health Categories

Page 23 GAO-14-246 NIH Priority Setting and Research Funding

Diseases and conditions

Leading cause 

of U.S. deaths

Leading cause 

of global deaths

Most prevalent U.S 

chronic diseases/ 

conditions

Research, Condition, and 

Disease Categorization 

system (RCDC)

Heart disease (coronary) x Heart disease – coronary heart 

disease

Heart disease (total) x Heart disease

HIV/AIDS x HIV/AIDS

Hypertension x Hypertension

Hypertensive heart disease x x Hypertension

Intentional self-harm (suicide)

a

x Suicide

Intentional self-harm (suicide) by 

discharge of firearms

x No RCDC match

Intentional self-harm (suicide) by other 

and unspecified means and their 

sequelae

x No RCDC match

Ischemic heart disease x x Heart disease – coronary heart 

disease

Lower respiratory infections

a

x Pneumonia: influenza

Malaria

b

x Malaria

Malignant neoplasms x Cancer

Malignant neoplasms of breast x Breast cancer

Malignant neoplasms of colon, rectum, 

and anus

x Colo-rectal cancer

Malignant neoplasms of liver, and 

intrahepatic bile ducts

x Liver cancer

Malignant neoplasms of lymphoid, 

hematopoietic and related tissue

x Lymphoma; childhood leukemia

Malignant neoplasms of pancreas x Pancreatic cancer

Malignant neoplasms of prostate x Prostate cancer

Malignant neoplasms of trachea, 

bronchus, and lung

x Lung cancer

Nephritis, nephrotic syndrome, and 

nephrosis

x Kidney disease

Non-transport accidents x No RCDC match

Obesity x Obesity

Parkinson’s disease x Parkinson’s disease

Pneumonia x Pneumonia

Pneumonitis due to solids and liquids x No RCDC match

Pneumonia and influenza x Pneumonia and influenza

Pre-term birth complications x Infant mortality/low birth weight; 

perinatal period – conditions 

originating in perinatal period
Appendix II: Leading Causes of Death and 

Chronic Conditions and their Corresponding 

National Institutes of Health Categories

Page 24 GAO-14-246 NIH Priority Setting and Research Funding

Diseases and conditions

Leading cause 

of U.S. deaths

Leading cause 

of global deaths

Most prevalent U.S 

chronic diseases/ 

conditions

Research, Condition, and 

Disease Categorization 

system (RCDC)

Renal failure x Kidney disease

Road injury x No RCDC match

Self-harm x Suicide

Septicemia x Septicemia

Stroke x Stroke 

Stroke (cerebrovascular disease) x Stroke 

Transport accidents x No RCDC match

Tuberculosis x Tuberculosis

Untreated dental caries x Dental/oral and craniofacial 

disease

Source: GAO analysis of Centers for Disease Control and Prevention data, Global Burden of Disease Study, and National Institutes of 

Health data.

a

a

NIH noted that while this RCDC category was the closest match, it is substantially broader than the 

disease or condition it was selected to represent.

b

NIH noted that while this RCDC category was the closest match, it is substantially narrower than the 

disease or condition it was selected to represent.
Appendix III: GAO Contact and Staff 

Acknowledgments

Page 25 GAO-14-246 NIH Priority Setting and Research Funding

Linda T. Kohn, Director, (202) 512-7114 or kohnl@gao.gov

In addition to the contact name above, Karen Doran (Assistant Director), 

George Bogart, Adrienne Daniels, Carolyn Feis Korman, Cathy Hamann, 

Natalie Herzog, Amy Leone, and Andrea Richardson made key 

contributions to this report.

Appendix III: GAO Contact and Staff 

Acknowledgments

GAO Contact

Staff 

Acknowledgments

(291144)
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